Airway management problem during anaesthesia. Airway management problem occurring in the Emergency Department
|
|
- Cori Greene
- 5 years ago
- Views:
Transcription
1 4th National Audit Project of the Royal College of Anaesthetists: Major Complications of Airway Management in the UK Please select one form from the list below Airway management problem during anaesthesia Airway management problem in ICU / HDU Airway management problem occurring in the Emergency Department Please note Airway problems in the Radiology Department may occur in patients undergoing anaesthesia in that department or in patients transferred to the Radiology Department from ICU or the Emergency Department for investigation. For these patients and for problems occurring in transit complete the form relating to the site of initial airway management. For example if a patient develops airway obstruction in the CT scanner following intubation on the ICU the form NAP4ICU should be completed. For problems occurring on Labour Ward please complete the form for airway management problem during anaesthesia Enter If you are not sure which form to select follow the links below for advice:- RCoA Audit Pack to be found at :- RCoA Powerpoint Presentation to be found at :- FAQ s to be found at :-
2 Inclusion Criteria 1. Please indicate the inclusion criteria by selecting one or more from the list below: Death Brain damage Emergency surgical airway or needle / cannula cricothroidotomy Unanticipated ICU admission 2. Please indicate the primary airway problem: - radio buttons to select any one Aspiration of gastro-oesophageal contents Failed mask ventilation LMA or supraglottic airway related problem Difficult or delayed intubation Failed intubation Tracheal tube misplacement Obstruction of tracheal tube or anaesthetic circuit CICV - the can t intubate can t ventilate scenario Iatrogenic airway trauma Extubation related problems Tracheostomy related problems Other Other [please specify free text limit to 50 letters] 2
3 3. What was the root cause of the poor outcome? Hypoxaemia due to airway obstruction Hypoxaemia due to tracheal tube misplacement or displacement Hypoxaemia due to equipment failure Aspiration of gastroesophageal contents Cardiac or neurological complications caused by hypo/hypertension during airway management Pharyngeal / oesophageal or other life-threatening soft-tissue trauma Other Yes No Yes No Yes No Yes No Yes No Yes No Yes No Other [please specify free text limit to 50 letters] 4. About the person(s) completing this form:- You are:- The clinician responsible for the patient s care (or one of team responsible for the patient s care): what is you job title? Free text limit to 50 letters The local reporter Both Clinician Job Title: free text limit to 50 letters..... Outcome Details 5. Please provide additional information on the inclusion criteria Death Please provide the cause of death. free text limit to 50 letters..... Brain damage Select the worst outcome observed Delayed awakening CVA Seizures Behavioural or cognitive impairment Other [please specify, free text limit to 50 letters] 3
4 Emergency surgical or needle/cannula airway Unanticipated ICU admission as a result of a problem with a airway management. Reason for ICU admission if appropriate Aspiration of gastro-oesophageal contents Myocardial infarction or cardiac problem Airway trauma/oedema Failure to awaken or elective ventilation to treat suspected brain injury Other [please specify, free text limit to 50 letters] 6. Outcome at time of form completion Death Partial recovery specify free text limit to 50 letters Full recovery 7. Time to recorded outcome from airway incident Immediate <24hrs 24hrs -1wk 1wk-1month >1mth 8. Please provide a brief description of the event. Do not include any patient identifying details free text limit to 250 letters
5 Circumstances Surrounding the Event 9. Please record the planned procedure, operation or presentation free text limit to 200 letters 10. NCEPOD urgency click the symbol for definitions Emergency Urgent Scheduled Elective 11. Grade of most senior anaesthetist who assessed the patient before anaesthesia None Professor Consultant Associate Specialist Staff Grade Trust Grade Specialist trainee ST 1-7 dropdown list to select one ST1, ST2, ST3, ST4, ST5, ST6, ST7 Other anaesthetist, please indicate : free text limit 20 letters 12. Was this person a locum anaesthetist? Yes No 13. Grade of most senior anaesthetists present at the start of airway event Anaesthetist 1 dropdown list to select one of the entire list in No.12 locum Yes No Anaesthetist 2 dropdown list to select one of the entire list in No.12 locum Yes No Grade of most senior surgeon present dropdown list to select one of the entire list in No.12 locum Yes No 14. Time of day of the airway event 00:00-08:00 08:01-18:00 18:01 24:00 5
6 15. Location of airway event Anaesthetic room Operating room Radiology department Recovery room Labour ward / maternity unit Hospital ward In transit between two of the above Other free text limit to 50 letters 16. Timing of event in relation to the anaesthetic At induction of general anaesthesia Intraoperative during general anaesthesia Intraoperative during local or regional anaesthesia Conversion of local or regional anaesthesia to general anaesthesia During emergence from anaesthesia or sedation Postoperative in recovery room Postoperative after discharge from recovery room Patient Characteristics at the time of the airway event 17. Gender Male Female Age < > 81 ASA Grade I / II / III / IV / V (click one option) Weight : kg Height : mts BMI 6
7 Body habitus cachectic 18. Co-morbidities normal obese Hypertension or ischaemic heart disease Left ventricular failure Aortic stenosis Chronic obstructive pulmonary disease Asthma Renal failure Liver disease Diabetes mellitus Obesity Other free text limit to 50 letters Obstructive sleep apnoea Pregnancy Scleroderma Rheumatoid arthritis Burns (acute or chronic) Congenital deformity of head/neck Previous radiotherapy to head/neck Anticoagulated 19. In trauma patients please list relevant major injuries free text limit to 50 letters 20. Were problems with ventilation or oxygenation evident or suspected before the airway event? Yes No. If yes Please indicate why? free text limit to 50 letters. Suspected cause/diagnosis. free text limit to 50 letters 21. What was the pre-event SpO 2 free numerals on what FiO 2 free numerals Airway Assessment 22. Was difficulty with airway management anticipated? Yes No If Yes Was this:- Difficult pre-oxygenation Difficult face mask ventilation 7
8 Difficult laryngoscopy and or intubation Difficult LM or SAD placement Difficult direct tracheal access 23. Was patient co-operation anticipated to be a problem? Yes No 24. Was an airway assessment recorded? Yes No. 25. Which of the following tests were performed and suggested a potential airway problem Mallampati Normal Abnormal Not done Mouth opening Normal Abnormal Not done Neck movement Normal Abnormal Not done Jaw protrusion Normal Abnormal Not done Thyromental distance Normal Abnormal Not done Sternomental distance Normal Abnormal Not done 26. Were special investigations performed to evaluate the airway? Yes No If yes indicate below CXR Reviewed by anaesthetist Yes No Neck Xray Reviewed by anaesthetist Yes No CT SCAN neck Reviewed by anaesthetist Yes No CT SCAN chest Reviewed by anaesthetist Yes No MRI neck Reviewed by anaesthetist Yes No MRI chest Reviewed by anaesthetist Yes No Fibreoptic nasendoscopy Reviewed by anaesthetist Yes No Other [Please specify which free text limit to 50 letters] 27. Was the patient at increased risk of aspiration? Yes No If yes Why? Recent ingestion Delayed gastric emptying Intestinal obstruction Pregnancy Gastroesophageal reflux Other specify free text limit to 50 letters 8
9 28. Was a history of airway problems available? Yes No If yes what was the type of problem? Specify free text limit to 50 letters Was the anaesthetist aware of this before inducing anaesthesia? Yes No If no what was the reason that the anaesthetist was not aware of this? free text limit to 50 letters 29. If the patient had previous airway problems or caused concern this information was:- Recorded in notes Yes No Recorded in anaesthetic dept Yes No Supplied to patient in writing Yes No Supplied to patient verbally Yes No Supplied to GP Yes No Contained on a Medicalert bracelet Yes No Unavailable at the time of the event Yes No The primary plan for anaesthesia For intra or post-operative airway events (i.e. not at induction) please record the anaesthetic plan used to manage the event 30. What was the primary anaesthetic plan? Please select one from list below:- General anaesthesia Regional anaesthesia +/- sedation Local anaesthesia + sedation Sedation only Local anaesthesia only 31. Please indicate below the primary airway management plan with regard to:- 1. Anaesthesia or sedation 2. Suppression of reflexes 3. The use of airway devices 9
10 31.1 Anaesthesia None General anaesthesia intravenous induction General anaesthesia inhalational induction IV sedation Intubation under local anaesthesia with or without sedation 31.2 Drugs used to suppress airway reflexes None Local anaesthetic agent - topical administration Local anaesthetic agent intravenous administration Opioid Suxamethonium Other neuromuscular blocking agent Other free text limit to 50 letters 31.3 Airway device primary plan None Hudson mask / nasal cannulae Anaesthetic facemask +/- oropharyngeal airway, Laryngeal mask airway, (LM) Another supraglottic device (SAD) specify free text limit to 20 letters Tracheal intubation (TI) (including fibreoptic intubation) New tracheostomy or cricothyroidotomy free text limit to 20 letters (Specify: surgical, large bore >3mm or small bore <3mm) Rigid bronchoscopy Use of already existing tracheostomy or tracheal tube Other free text limit to 50 letters 10
11 Conduct of Anaesthesia 32. Were there any relevant problems with the anaesthetic equipment? Yes No Was the equipment checked beforehand? Yes No 33. Please indicate below who checked the anaesthetic equipment before use 1. Anaesthetist Yes No 2. ODP/anaesthetic nurse Yes No 3. Both 1 and 2 Yes No 34. Please indicate the monitoring devices in use employed at the onset of the airway event SpO 2 Yes No ECG Yes No EtCO 2 Yes No FiO 2 Yes No NIBP Yes No Invasive BP Yes No Inspired agent monitor Yes No Depth of neuromuscular blockade Yes No 11
12 Airway Management Techniques Employed Please examine the following lists very carefully, then select in order each of the techniques used. Your selections will appear in order in the box opposite questions 38 and 39. If you revert to a technique used previously please record each attempt: for example if bag mask ventilation was employed first, then failed and a disposable LM was employed, which failed and then facemask was attempted again for facemask should appear first and third on the list and the disposable LM should be second. When the list is complete please check that the final order is correct, incorrect entries may be removed with the button below. 35. Pre-oxygenation With Hudson type mask With anaesthetic mask and circuit 36. Non intubation airway maintenance Facemask +/-oropharyngeal / nasal airway Classic LMA Disposable LM: which? free text limit to 20 letters ILMA Proseal LMA Flexible LMA igel Combitube Other free text limit to 20 letters 37. Tracheal intubation with direct laryngoscopy Macintosh laryngoscopy without bougie Macintosh laryngoscope with bougie Straightblade laryngoscope without bougie Straightblade laryngoscope with bougie McCoy without bougie McCoy with bougie Other free text limit to 20 letters Other laryngoscope Lighted bougie 38. Flexible fibreoptic intubation +/- aids Flexible fibreoptic intubation using a tracheal tube. Flexible fibreoptic intubation through an SGA (including ILMA) using a tracheal tube. Flexible fibreoptic intubation using an Aintree catheter. Flexible fibreoptic intubation through an SGA (including ILMA) using an Aintree catheter. Flexible fibreoptic intubation using a guidewire. Flexible fibreoptic intubation through an SGA (including ILMA) using a guidewire. 39. With a rigid indirect laryngoscope Pentax AWS Upsher Bullard Wu Glidescope Airtraq TruView / Viewmax McGrath Other free text limit to 20 letters 40. With optical stylet Bonfils Levitan SOS (Shikani) Other Specify free text limit to 20 letters 41. With a conduit CTrach 42. Blind intubation Nasal apnoeic Nasal spontaneous respiration Oral apnoeic Oral spontaneous respiration ILMA without fibreoptic endoscope 43. Direct airway access Fine bore < 3mm needle/cannula cricothyroidotomy Wide bore > 3mm cannula cricothyroidotomy uncuffed Wide bore > 3mm cannula cricothyroidotomy cuffed Surgical cricothyroidotomy uncuffed Surgical cricothyroidotomy cuffed Surgical tracheostomy Percutaneous tracheostomy 44. Other free text limit to 50 letters 12
13 Confirmation of tracheal tube placement 45. Was tracheal tube misplacement the primary airway problem? Yes No (go to 48) 46. How was correct tracheal tube placement confirmed? Tracheal intubation was not performed Tracheal tube seen to pass between cords Observation of bilateral chest movement Auscultation Oesophageal detector device (Wee type balloon or syringe test) Disposable CO 2 detector End tidal CO 2 measurement Fibreoptic visualisation of carina Improvement in oxygenation No active effort made to confirm position 47. At what stage did the airway event which caused this patient to meet the inclusion criteria occur? At or before induction During the procedure At emergence or after anaesthesia Yes Yes Yes Intraoperative problems 48. Did the airway event develop intra-operatively i.e. not at induction, on emergence or following anaesthesia? Yes please continue No (go to 60) 49. Problems developed with:- Oxygenation Ventilation Tracheal tube displacement Supraglottic airway displacement Airway obstruction 13
14 50. What was the cause of the problem? free text limit to 30 letters 51. When did this become apparent? In the anaesthetic room On transfer to the operating room After change of position During a change of technique At change of anaesthetist During routine maintenance without warning During routine maintenance caused by another problem eg anaphylaxis please specify free text limit to 30 letters 52. Were lung isolation techniques being employed? Yes No If yes how was this performed:- Double lumen tube Single lumen tube with bronchial blocker 53. Patient position Supine Prone Lateral Lithotomy Other free text limit to 30 letters 54. Was access to the airway limited by the site of the operation? Yes No 55. Was access to the airway limited by the patient s position? Yes No 56. Were there problems occurred with the anaesthetic circuit, ventilator or monitoring equipment? Yes No 57. Was the airway device displaced? Yes No 58. Was the airway device obstructed? Yes No 59. Was the airway device perforated or divided? Yes No 14
15 Airway problems at the end of anaesthesia 60. Did the airway event develop on emergence from, or after anaesthesia? Yes No (go to 65) 61. Where did this occur? Operating room In transit between operating room and recovery area Recovery area In transit to ward On ward 62. What was the problem? Airway obstruction, Hypoventilation Other free text limit to 30 letters 63. Was this problem apparent immediately after extubation or removal of SAD? Yes No 64. Did the airway problem follow airway problems at induction or during the procedure. Yes No If yes please provide this information later in the free text section at the end of the form Details of anaesthesia and airway management In the following sections please provide details on the anaesthetic techniques used to manage the airway event. 65. Was sedation used without general anaesthesia to manage the airway problem? Yes No (go to 70) 66. Drugs used for sedation Drug name free text limit to 20 letters. Bolus administration Yes No Infusion Yes No TCI Yes No Drug name free text limit to 20 letters. Bolus administration Yes No Infusion Yes No TCI Yes No Drug name free text limit to 20 letters. Bolus administration Yes No Infusion Yes No TCI Yes No Drug name free text limit to 20 letters. Bolus administration Yes No Infusion Yes No TCI Yes No 15
16 67. Sedation, please record the highest score achieved 1. Awake 2. Drowsy responding to commands appropriately 3. Drowsy responding to commands inappropriately 4. Responding to physical stimulus only 5. Unresponsive 68. Was Supplementary O 2 delivered? Yes No 69. Was exhaled CO 2 monitored? Yes No Intubation under local anaesthesia with or without sedation 70. Was intubation under local anaesthesia without a general anaesthetic employed to manage the airway problem? Yes No (go to 81) 71. Please indicate below the intubation method(s) employed or attempted Direct laryngoscopy Blind intubation (specify technique) free text limit to 50 letters Flexible fibreoptic intubation Rigid fibreoptic intubation (specify) free text limit to 50 letters Surgical airway Other (e.g. via ILMA, Bonfils, videoscope) (specify) free text limit to 50 letters 72. Which route was planned? Oral / Nasal / Tracheostomy click one option) 73. Was IV access obtained before the airway event? Yes No Method of airway anaesthesia 74. Was an anticholinergic agent given? Yes No If yes Drug Atropine / Glycopyrrolate / Hyoscine click one option) Route Intravenous / Intramuscular click one option) Dose in microgrammes free numerals Route and time lapse between administration and start of airway anaesthesia IV 0 mins / 0-10 mins / /20-60 / >60 click one option) IM 0 mins / 0-15 mins / / / / >120 click one option) 75. Local anaesthetic technique, which of the following were employed? 16
17 Lidocaine/other Other free text limit to 20 letters click one option Dose free numerals Nebulisation Nerve blocks Trans-laryngeal/ tracheal anaesthesia Spray as you go topical via a fibrescope Other free text limit to 30 letters 76. Was local anaesthesia supplemented by sedatives / opioids / induction agent? Yes No 77. How was supplementary oxygen delivered during endoscopy? Not used/ via endoscope/ nasal cannula(e) / open mask / anaesthetic circuit click one option 78. Type and size of tracheal tube used at 1 st attempt Type free text limit to 20 letters size free numerals Type and size of tracheal tube used at last attempt. Typefree text limit to 20 letters size free numerals Intubation under local anaesthesia Succeeded failed 79. Problems observed during intubation under local anaesthesia. Please select more than one if necessary Lack of cooperation Inadequate analgesia Airway obstruction from excess sedation Airway obstruction from other cause free text limit to 20 letters Bleeding Contamination with secretions LA toxicity Inability to pass tracheal tube Equipment failure 80. Primary reason for failure of intubation under local anaesthesia. Please select one Lack of cooperation Inadequate analgesia Airway obstruction from excess sedation 17
18 Airway obstruction from other cause Bleeding Contamination with secretions LA toxicity Inability to pass tracheal tube Equipment failure Inhalational or spontaneous breathing general anaesthesia 81. Was inhalational or spontaneously breathing general anaesthesia used to manage the airway problem? Yes No (go to 93) 82. Was an IV Access obtained before the airway event? Yes No 83. Was an anticholinergic agent administered? Yes No If yes which drug Atropine / Glycopyrrolate / Hyoscine (select one or more) 84. Which gases were used? N 2 O / Air / Helium (select one or more) FiO 2 free numerals with decimal point. 85. Which inhalational agents were used? Indicate 1 st then 2 nd and 3 rd if more than one was used. Halothane click one option) Enflurane next line to select any other two / one option only Isoflurane Desflurane Sevoflurane 86. Was inhalational anaesthesia supplemented by sedatives, opioids or an induction agent? Yes No Drug free text limit to 30 letters Drug free text limit to 30 letters. Drug free text limit to 30 letters. 87. Was supplementary local anaesthetic used? Topical application Yes No drug free text limit to 30 letters. IV administration Yes No drug free text limit to 30 letters. 88. Indicate if any of the following difficulties arose during inhalational induction:- 18
19 Airway obstruction including laryngospasm Regurgitation SpO 2 < 90% Other specify free text limit to 30 letters 89. Was direct laryngoscopy attempted? Yes No If yes please grade laryngoscopy conditions Good / adequate / inadequate click one option) 90. Was tracheal intubation attempted? Yes No If yes please grade intubation conditions Good / adequate / inadequate click one option) 91. What was the primary endpoint selected to indicate adequate depth of anaesthesia for airway instrumentation? None Pupillary signs Reduction in blood pressure Change in respiratory rate Respiratory pattern Time End tidal inhalational agent concentration Other free text limit to 30 letters 92. Was a neuromuscular blocking agent given before direct laryngoscopy? Yes No If yes record drug free text limit to 20 letters dose free numerals mg. Intravenous general anaesthesia including muscle relaxants and / or TIVA 93. Was Intravenous general anaesthesia or TIVA used to manage the airway problem? Yes No go to Was rapid sequence induction (RSI) planned? Yes No 95. Was the patient pre-oxygenated? Yes No If yes why was the patient pre-oxygenated? RSI / routine / pre-existing hypoxaemia / airway problem anticipated If no Why not? not considered necessary / patient uncooperative / time pressure (select one or more) (select one or more) 96. Which of the following most closely resembles the method of preoxygenation 19
20 100% O 2 for 3 minutes 3 vital capacity breaths Measured end-tidal O 2 level >90% before induction. Other 97. Induction agent (click one option) STP / propofol / etomidate / ketamine/ midazolam / other specify free text limit to 20 letters 98. Opioids used at or before induction (select one or more) None / fentanyl / alfentanil / morphine / remifentanil / other specify free text limit to 20 letters 99. Muscle relaxant used at induction (select one or more) None / suxamethonium / atracurium / rocuronium / other free text limit to 20 letters Dose of muscle relaxant free numerals mg Was cricoid force applied? Yes No If yes Were there problems associated with the application of cricoid force? Yes No Was this released before confirmed tracheal intubation? Yes No If so did laryngoscopic view improve? Yes No Were gastric contents seen in the oropharynx? Yes No If so when? Before release of cricoid force After release of cricoid force 101. Were there any problems with IV access or drug delivery? Yes No Lost access Lost drugs Other free text limit to 50 letters Mask ventilation and tracheal intubation 102. Was mask ventilation or tracheal intubation employed to manage the airway event? Yes No go to Initial spontaneous ventilation Maintenance of airway with facemask was Maintenance of airway by (SAD) was 104. Initial manual ventilation Initial ventilation via mask was Optimal / impaired / inadequate / impossible / not attempted (click one option) Optimal / impaired / inadequate / impossible / not attempted click one option) Drop down list of definitions when cursor is on an option Optimal. Achieved without multiple attempts and without difficulty or complications. Impaired. Less than optimal but achieved and able to be continued. Inadequate. Barely achieved and once achieved not sustainable for prolonged period. Impossible. Not achieved despite best efforts. Optimal / impaired / inadequate / impossible / not attempted click one option) 20
21 Initial ventilation via LMA or SAD was The initial ventilation via tracheal tube was Optimal / impaired / inadequate / impossible / not attempted click one option) Optimal / impaired / inadequate / impossible / not attempted click one option) Drop down list of definitions when cursor is on an option Optimal. Achieved without multiple attempts and without difficulty or complications. Impaired. Less than optimal but achieved and able to be continued. Inadequate. Barely achieved and once achieved not sustainable for prolonged period. Impossible. Not achieved despite best efforts Was laryngoscopy attempted? Yes No Best view on direct laryngoscopy was 1 / 2a / 2b / 3a / 3b / 4 / D/L not performed / not recorded click one option If the view was poor was OELM or BURP performed? Yes No 106. On initial laryngoscopy the larynx was Normal / distorted /abnormal / not seen / not recorded click one option)) Was intubation difficult despite adequate laryngeal view? Yes No If yes why? free text limit to 50 letters Did the ability to manage the airway change? Yes No If yes what changed? Mask ventilation became Optimal / impaired / inadequate / impossible / unchanged click one option) Ventilation via supraglottic airway device became Optimal / impaired / inadequate / impossible / unchanged click one option) 108. During intubation attempts did any of the following materially impede intubation:- Regurgitation Yes No Bleeding into the airway Yes No Oedema Yes No Excessive secretions Yes No Pus Yes No 109. In total how many attempts were made to perform tracheal intubation? 0 / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 10+ click one option) 110. Was fibreoptic intubation performed or attempted? Yes No After how many previous attempts at tracheal intubation was fibreoptic intubation attempted? 0 / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 10+ click one option) 111. Was fibreoptic intubation performed or attempted through a supraglottic airway? Yes No After how many previous attempts at tracheal intubation was fibreoptic intubation through a supraglottic airway performed? 0 / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 10+ click one option) 112. What was the time from the start of problems to securing the airway or abandonment? hh:mm 113. For how long was ventilation difficult or absent? free numerals hh:mm About hypoxia 114. For how long was oxygenation poor (SpO 2 recorded or estimated to be <85%) free numeralshh:mm Profound hypoxia 115. For how long was oxygenation very poor (SaO2 recorded or estimated to be <70%) free numeralshh:mm 116. What was the lowest recorded SpO 2? free numerals 117. Was effective ventilation and oxygenation achieved? Yes No At this point what was the SpO 2 free numerals on what FiO 2 free numerals About facemask ventilation 118. Were problems experienced with mask ventilation during management of the airway event? Yes No (go to 126) 119. Indicate the methods employed below Bag- mask ventilation / jaw thrust / an oropharyngeal airway / multi-person bag-mask ventilation It was possible to maintain oxygenation or an SpO 2 > 85% 21
22 Throughout Initially possible but not possible later, i.e. situation deteriorated Initially not possible but possible later i.e. situation improved Never, at any stage was ventilation possible 120. Number of hands used dropdown list One /Two / Three / Four / Five / Six 121. Mask type free text limit to 20 letters Please indicate the cause of problems with mask ventilation? 122. Ineffective seal due to Beard Facial deformity Radiotherapy Swelling Obesity Burns Trismus Limited access to airway 123. Loss of gas pressure Gas failure Circuit failure 124. Airway obstruction Limited mouth opening, Limited neck extension Lesion of or within the airway (including tumour, laryngeal oedema or foreign body) Laryngospasm Regurgitation 125. Other causes of failure please list free text limit to 50 letters Use of supraglottic airway devices 126. Were problems experienced with a supraglottic airway during the management of the airway event? Yes No (go to 133) 127. Device(s) used free text limit to 20 letters 128. Anticipated problems free text limit to 50 letters 129. Actual problems free text limit to 50 letters 130. Were all necessary sizes available? Yes No 131. If a supraglottic device was used to relieve upper airway obstruction did it succeed? Yes No 132. If a supraglottic device failed what was the cause of failure? 22
23 Inability to insert Gas leak/ poor seal Airway obstruction Regurgitation Flexible Fibreoptic intubation 133. Was flexible fibreoptic intubation attempted or performed during the management of the airway event? Yes No (go to 143) 134. Was this attempted or performed under local or general anaesthesia? You may select both if this is appropriate. General anaesthesia Local 135. Was an oropharyngeal guide used? Yes No If yes go to Which ones were tried? Patil Berman Breathesafe Other free text limit to 20 letters 136. Was a supraglottic airway used as a guide? Yes No If yes go to Which ones were tried? LMA classic ILMA disposable LM igel Other please specify free text limit to 20 letters 137. Was the trachea located with fibrescope Yes No 138. If more than one guide was used please indicate the one which was effective free text limit to 20 letters 139. What type of tracheal tube was used Size free numerals Type free text limit to 20 letters 140. Was difficulty encountered passing the tracheal tube? Yes No 23
24 141. Was an Aintree intubation catheter used Yes No 142. Were problems observed during flexible fibreoptic intubation?: Yes No Inadequate anaesthesia Airway obstruction Contamination with blood or secretions Inability to pass tracheal tube Equipment failure Direct tracheal access 143. Was direct tracheal access attempted or obtained during the management of the airway event? Yes No (go to 152) 144. Indicate which was / were performed Surgical tracheostomy Surgical cricothyroidotomy Fine bore cannula cricothyotomy < 3 mm Large bore cannula cricothyroidotomy > 3 mm Percutaneous tracheostomy Was the device cuffed uncuffed click one option 145. Which specific devices were used? free text limit to 30 letters successful / failed click one option By Whom 1 st user Speciality free text limit to 20 letters Grade dropdown list to select one of the entire list in No.12 2 nd user Speciality free text limit to 20 letters Grade dropdown list to select one of the entire list in No.12 3 rd user Speciality free text limit to 20 letters Grade dropdown list to select one of the entire list in No How many attempts were made before the device was successfully placed in the trachea or was abandoned? 1 / 2 / 3 / 4 / 5 / 6 click one option 147. How long did the procedure take? hh:mm 148. How was placement confirmed? Aspiration of air Observation of chest rising and falling 24
25 Capnography Auscultation Improved oxygenation inspection with fibrescope 149. Once placed did it provide effective oxygenation? Yes No 150. What mode of ventilation was used? High pressure source ventilation: (if selected go to next line) Manujet, Sanders injector. Other high pressure device specify free text limit to 50 letters HFJV Low pressure source ventilation: (if selected go to next line) Anaesthesia machine flush Anaesthetic circuit Other specify free text limit to 50 letters 151. Were any complications seen? Bleeding Surgical emphysema Pneumothorax Pneumomediastinum Other please list free text limit to 30 letters 25
26 Availability of Help 152. Please record the grade of those present at induction of anaesthesia Anaesthetist 1 dropdown list to select one of the entire list in No.12 Anaesthetist 2 dropdown list to select one of the entire list in No.12 Anaesthetist 3 dropdown list to select one of the entire list in No.12 Most senior surgeon present dropdown list to select one of the entire list in No Please record the grade of anaesthetists present at the time the airway problem became apparent Anaesthetist 1 dropdown list to select one of the entire list in No.12 Anaesthetist 2 dropdown list to select one of the entire list in No.12 Anaesthetist 3 dropdown list to select one of the entire list in No.12 Most senior surgeon present dropdown list to select one of the entire list in No Was additional help/advice was requested? Yes If yes when No Before the airway problem became apparent At the time the airway problem became apparent When initial attempts to manage the problem failed After the problem had been managed 155. At what stage was help requested? Pre induction Induction Post induction Perioperatively Postoperatively 156. How long did it take for help to arrive? <1 minute / 1-4 minutes / 5-30 minutes / >30 minutes click one option 157. Help was requested from whom? And had they been informed or consulted before the event? Grade Specialty informed before event Request 1 dropdown list to select one of the entire list in No.12 free text limit to 30 letters Yes No 26
27 Request 2 dropdown list to select one of the entire list in No.12 free text limit to 30 letters Yes No Request 3 dropdown list to select one of the entire list in No.12 free text limit to 30 letters Yes No Request 4 dropdown list to select one of the entire list in No.12 free text limit to 30 letters Yes No 158. Was an alternative anaesthetic technique available? Yes No 159. Was an alternative technique discussed? Yes No 160. Was it essential to proceed after the event occurred? Yes No 161. If tracheal intubation was attempted please list the grade of each intubator and the number of intubation attempts each made Intubator Grade Specialty Number of attempts 1st Intubator dropdown list to select one of the entire list in No.12 free text limit to 30 letters free numerals 2 nd dropdown list to select one of the entire list in No.12 free text limit to 30 letters free numerals 3 rd dropdown list to select one of the entire list in No.12 free text limit to 30 letters free numerals 4 th dropdown list to select one of the entire list in No.12 free text limit to 30 letters free numerals 5 th dropdown list to select one of the entire list in No.12 free text limit to 30 letters free numerals 162. List the anaesthetists present at the start, during or at the end of the event? Please give grades. At the start During At the end Doctor 1 dropdown list to select one of the entire list in No.12 Yes No Yes No Yes No Doctor 2 dropdown list to select one of the entire list in No.12 Yes No Yes No Yes No Doctor 3 dropdown list to select one of the entire list in No.12 Yes No Yes No Yes No Doctor 4 dropdown list to select one of the entire list in No.12 Yes No Yes No Yes No Doctor 5 dropdown list to select one of the entire list in No.12 Yes No Yes No Yes No Doctor 6 dropdown list to select one of the entire list in No.12 Yes No Yes No Yes No Availability of equipment 163. Which piece of equipment most effectively improved the clinical condition? free text limit to 50 letters How long did it take to arrive? hh:mm 163. Was all the equipment you needed to deal with this airway problem available Yes No If no what was the root cause of the lack of availability? free text limit to 50 letters 165. Was available equipment not used due to lack of appropriate skills Yes No If yes which items? free text limit to 50 letters 27
28 Supplementary information 166. Please record any additional information that will facilitate understanding of what occurred. Do not include any information identifying the patient, the hospital or the clinician. free text limit to 200 letters 167. What went well? free text limit to 200 letters 168. What went badly? free text limit to 200 letters 169. Which of the following played an important role in the poor outcome? Defective knowledge Defective judgement Inadequate or malfunctioning equipment Defective training Team behaviour 28
Airway management problem occurring in the Emergency Department
NAP4EM Airway management problem occurring in the Emergency Department Inclusion criteria 1. Please indicate the inclusion criteria by selecting one or more from the list below: Death Brain damage Emergency
More informationAirway management problem during anaesthesia. Airway management problem in ICU / HDU. Airway management problem occurring in the Emergency Department
4th National Audit Project of the Royal College of Anaesthetists: Major Complications of Airway Management in the UK Please select one form from the list below Airway management problem during anaesthesia
More informationGENERAL ANAESTHESIA AND FAILED INTUBATION
GENERAL ANAESTHESIA AND FAILED INTUBATION INTRODUCTION The majority of caesarean sections in the UK are performed under regional anaesthesia. However, there are situations where general anaesthesia (GA)
More informationDiagnosis & Management of the Difficult Airway
Diagnosis & Management of the Difficult Airway Dr. E. Rawlings Plymouth Anaesthetic Department Complications of Airway Management Medicolegal Serious morbidity Mortality Complications of Airway Management
More informationAIRWAY MANAGEMENT AND VENTILATION
AIRWAY MANAGEMENT AND VENTILATION D1 AIRWAY MANAGEMENT AND VENTILATION Basic airway management and ventilation The laryngeal mask airway and Combitube Advanced techniques of airway management D2 Basic
More informationDIFFICULT AIRWAY MANAGMENT. Dr.N.SANTHOSH KUMAR MD ANESTHESIA (2 nd Yr)
DIFFICULT AIRWAY MANAGMENT Dr.N.SANTHOSH KUMAR MD ANESTHESIA (2 nd Yr) AIRWAY MANAGEMENT AND MAINTAINING OXYGENATION ARE THE FUNDAMENTAL RESPONSIBILITIES OF ANY BASIC DOCTOR. TO MANAGE A DIFFICULT AIRWAY,
More informationOther methods for maintaining the airway (not definitive airway as still unprotected):
Page 56 Where anaesthetic skills and drugs are available, endotracheal intubation is the preferred method of securing a definitive airway. This technique comprises: rapid sequence induction of anaesthesia
More informationAdvanced Airway Management. University of Colorado Medical School Rural Track
Advanced Airway Management University of Colorado Medical School Rural Track Advanced Airway Management Basic Airway Management Airway Suctioning Oxygen Delivery Methods Laryngeal Mask Airway ET Intubation
More informationDr.Bharghavi.M 2 nd year post graduate Dept of Anaesthesia
DIFFICULT AIRWAY CANNOT VENTILATE, CANNOT INTUBATE. Dr.Bharghavi.M 2 nd year post graduate Dept of Anaesthesia Difficult airway According to AMERICAN SOCIETY OF ANAESTHESIOLOGISTS Difficult Airway is defined
More informationThe 2015 DAS Guidelines
The 2015 DAS Guidelines Housekeeping & provenance Housekeeping & provenance Preparation for intubation Algorithms New Plans A-D New features Housekeeping 2004 2009 2011 2012 2015 2004 2009 2011 2012 2015
More informationAirway Management. Teeradej Kuptanon, MD
Airway Management Teeradej Kuptanon, MD Outline Anatomy Detect difficult airway Rapid sequence intubation Difficult ventilation Difficult intubation Surgical airway access ICU setting Intubation Difficult
More informationAnaesthetic Plan And The Practical Conduct Of Anaesthesia. Dr.S.Vashisht Hillingdon Hospital
Anaesthetic Plan And The Practical Conduct Of Anaesthesia Dr.S.Vashisht Hillingdon Hospital Anaesthetic Plan Is based on Age / physiological status of the patient (ASA) Co-morbid conditions that may be
More information(ix) Difficult & Failed Intubation Queen Charlotte s Hospital
(ix) Difficult & Failed Intubation Queen Charlotte s Hospital Pre-operative Assessment Clinical assessment of airway and risk of difficult intubation: (can be performed in a matter of seconds): 1. Mouth
More informationQuestion: Is this patient an infant? A patient less than 12 months old is considered an infant. Please check the box next to the appropriate choice.
Question: Date of Intubation (Month, Day, Year): Question: Date of Data Entry This should be within 4 weeks to the day of intubation: Question: Is this patient an infant? A patient less than 12 months
More informationComparison of the Berman Intubating Airway and the Williams Airway Intubator for fibreoptic orotracheal intubation in anaesthetised patients.
Title Comparison of the Berman Intubating Airway and the Williams Airway Intubator for fibreoptic orotracheal intubation in anaesthetised patients Author(s) Greenland, KB; Ha, ID; Irwin, MG Citation Anaesthesia,
More informationKelowna June 2011 Airway Assessment and Management. Golden, BC
Kelowna June 2011 Airway Assessment and Management Dr. Bruce Starke Golden, BC Not really... I am unable to identify any potential conflict of interest and I am unable to identify any potential conflict
More informationPreface... Acknowledgements... Contributors... 1 The Difficult Airway: Definitions and Algorithms The Expected Difficult Airway...
Contents Preface... Acknowledgements... Contributors... vii ix xvii 1 The Difficult Airway: Definitions and Algorithms... 1 Zdravka Zafirova and Avery Tung Introduction 1 Definitions 2 Incidence 3 Algorithms
More informationINternational observational study To Understand the impact and BEst practices of airway management in critically ill patients CASE REPORT FORM
INternational observational study To Understand the impact and BEst practices of airway management in critically ill patients Study acronym identifier: INTUBE CASE REPORT FORM Centre ID number: Patient
More informationRisky Extubation. Andy Higgs. Warrington Hospitals Cheshire UK
Andy Higgs Warrington Hospitals Cheshire UK Declaration COOKMEDICAL Extubation plan DAS guideline Airway Exchange Catheters # 11 CAEC post maxillo-facial surgery Used as intubation stylets Airway Exchange
More informationAnatomy and Physiology. The airways can be divided in to parts namely: The upper airway. The lower airway.
Airway management Anatomy and Physiology The airways can be divided in to parts namely: The upper airway. The lower airway. Non-instrumental airway management Head Tilt and Chin Lift Jaw Thrust Advanced
More informationEmergency ENT Anaesthesia. Richard Semenov
Emergency ENT Anaesthesia Richard Semenov Emergency ENT Anaesthesia Dr Richard Semenov MBBS (Adel) FRCA (UK) FANZCA Dept of Anaesthesia Royal Adelaide Hospital My Experience in Emergency ENT Anaesthesia
More informationMajor complications of airway management in the United Kingdom
The Royal College of Anaesthetists The Difficult Airway Society 4th National Audit Project of The Royal College of Anaesthetists and The Difficult Airway Society Major complications of airway management
More informationASPIRATION DURING ANAESTHESIA
ASPIRATION DURING ANAESTHESIA MODULE: CRITICAL INCIDENTS TARGET: ALL ANAESTHETISTS BACKGROUND: Passive regurgitation or vomiting can occur during the pre-, peri- or post- operative period risking aspiration
More informationAirway Workshop Lecture. University of Ottawa
Airway Workshop Lecture Department of Anesthesiology University of Ottawa Overview Ventilation Airway assessment Difficult airways Airway management equipment aids Intubation/Improving Intubation Success
More informationAirway Management. Key points. Rapid Sequence Intubation. Rapid Sequence Intubation Recognizing difficult airway Managing difficult airway
Airway Management Prasha Ramanujam and Guy Shochat Department of Emergency Medicine UCSF Medical Center Key points Rapid Sequence Intubation Recognizing difficult airway Managing difficult airway Rapid
More informationAustralian and New Zealand College of Anaesthetists (ANZCA)
PS61 2017 Australian and New Zealand College of Anaesthetists (ANZCA) Guidelines for the Management of Evolving Airway Obstruction: Transition to the Can t Intubate Can t Oxygenate Airway Emergency 1.
More informationIf you suspect airway problems, get a second opinion before you anaesthetise, not after!
Assessing the airway It is more important to be aware of the various methods of dealing with difficult laryngoscopy than to expect to be able to accurately identify the rare difficult patients without
More informationAirway Anatomy. Soft palate. Hard palate. Nasopharynx. Tongue. Oropharynx. Hypopharynx. Thyroid cartilage
Airway Anatomy Hard palate Soft palate Tongue Nasopharynx Oropharynx Hypopharynx Thyroid cartilage Airway Anatomy Hyoid bone Thyroid cartilage Cricoid cartilage Trachea Cricothyroid membrane Airway Anatomy
More informationSubspecialty Rotation: Anesthesia
Subspecialty Rotation: Anesthesia Faculty: John Heaton, M.D. GOAL: Maintenance of Airway Patency and Oxygenation. Recognize and manage upper airway obstruction and desaturation. Recognize and manage upper
More informationSECTION 1: INCLUSION, EXCLUSION & RANDOMISATION INFORMATION
SECTION 1: INCLUSION, EXCLUSION & RANDOMISATION INFORMATION DEMOGRAPHIC INFORMATION Given name Family name Date of birth Consent date Gender Female Male Date of surgery INCLUSION & EXCLUSION CRITERIA YES
More informationCase Presentation Topic: Difficult to Ventilate Difficult to Intubate
Case Presentation Topic: Difficult to Ventilate Difficult to Intubate Dr. K. Shruthi Jeevan 1 st Year Post Graduate Department of Anaesthesiology CASE SCENARIO : 1 A 65 years old female patient, resident
More informationBasic Scope Care and Handling
Basic Scope Care and Handling Basic principles behind fibre-optic instruments Light and image transfer via coherent(image transmission) and incoherent (light)bundles Fibre coating with lower refractory
More informationAirway/Breathing. Chapter 5
Airway/Breathing Chapter 5 Airway/Breathing Introduction Skillful, rapid assessment and management of airway and ventilation are critical to preventing morbidity and mortality. Airway compromise can occur
More informationAll bedside percutaneously placed tracheostomies
Page 1 of 5 Scope: All bedside percutaneously placed tracheostomies Population: All ICU personnel Outcomes: To standardize and outline the steps necessary to safely perform a percutaneous tracheostomy
More informationTRACHEOSTOMY EMERGENCIES
TRACHEOSTOMY EMERGENCIES MODULE: AIRWAY TARGET: ALL ANAESTHETISTS, INTENSIVISTS, ED & ACUTE PHYSICIANS, FOUNDATION DOCTORS BACKGROUND: Around 16% of ICU patients may have a tracheostomy. Life- threatening
More informationExclusion Criteria 1. Operator or supervisor feels specific intra- procedural laryngoscopy device will be required.
FELLOW Study Data Analysis Plan Direct Laryngoscopy vs Video Laryngoscopy Background Respiratory failure requiring endotracheal intubation occurs in as many as 40% of critically ill patients. Procedural
More informationSuggested items to be included in obstetric anaesthesia records
Suggested items to be included in obstetric anaesthesia records This list is intended as a guide to what fields could be included in an anaesthesia record used in obstetric practice. It is merely a suggested
More informationAdvanced Airway Management PRESENTED BY: JOSIAH POIRIER RN, JOHN GRUBER FP-C
Advanced Airway Management PRESENTED BY: JOSIAH POIRIER RN, JOHN GRUBER FP-C Advanced Airway Objectives Advanced airway management is a relatively low frequency, high risk intervention. The following education
More informationGeneral OR Rotations GOALS & OBJECTIVES
General OR Rotations GOALS & OBJECTIVES Goals At the end of the CA 1 year General OR rotations, the resident should competently manage uncomplicated ambulatory, orthopedic, maxillo-facial, ENT, gynecologic,
More informationPAEDIATRIC ANAESTHETIC EMERGENCIES PART I. Dr James Cockcroft, South West School of Anaesthesia. Dr Sarah Rawlinson, Derriford Hospital, Plymouth, UK
PAEDIATRIC ANAESTHETIC EMERGENCIES PART I Original Article by: Dr Claire Todd, South West School of Anaesthesia Dr James Cockcroft, South West School of Anaesthesia Dr Sarah Rawlinson, Derriford Hospital,
More informationTracheostomy and laryngectomy airway emergencies: an overview for medical and nursing staff
2013 Medical Journal Tracheostomy and laryngectomy airway emergencies: an overview for medical and nursing staff Steven Lobaz 1 and Paul Bush 2 1 ST6 and 2 Consultant Department of Anaesthesia and Intensive
More informationANESTHESIA EXAM (four week rotation)
SPARROW HEALTH SYSTEM ANESTHESIA SERVICES ANESTHESIA EXAM (four week rotation) Circle the best answer 1. During spontaneous breathing, volatile anesthetics A. Increase tidal volume and decrease respiratory
More informationADVANCED AIRWAY MANAGEMENT
The Advanced Airway Management protocol should be used on all patients requiring advanced airway management procedures. This protocol is divided into three sections the Crash Airway Algorithm, the Rapid
More informationCASE REPORT FORM (v )
INternational observational study To Understand the impact and BEst practices of airway management in critically ill patients Study acronym identifier: INTUBE CASE REPORT FORM (v 1.2 30.09.18) SITE INFORMATION
More informationIn 2011 I received an unrestricted lecture honorarium from Ambu I have been loaned equipment by Intavent Direct (Teleflex) and Aircraft Medical As an
Alistair McNarry In 2011 I received an unrestricted lecture honorarium from Ambu I have been loaned equipment by Intavent Direct (Teleflex) and Aircraft Medical As an organiser of airway workshops I have
More informationJoint Theater Trauma System Clinical Practice Guideline
Page 1 of 7 Joint Theater Trauma System Clinical Practice Guideline TRAUMA AIRWAY MANAGEMENT Original Release/Approval 18 Dec 2004 Note: This CPG requires an annual review. Reviewed: May 2012 Approved:
More informationVolume of practice and workplace-based assessment requirements for each of the ANZCA Clinical Fundamentals
Appendix Four Volume of practice and workplace-based assessment requirements for each of the ANZCA Clinical Fundamentals This appendix contains tables setting out both the volume of practice and workplace-based
More informationDifficult Airway. Victor M. Gomez, M.D. Pulmonary Critical Care Medicine Medical City Dallas Hospital
Difficult Airway Victor M. Gomez, M.D. Pulmonary Critical Care Medicine Medical City Dallas Hospital Difficult Airway Definition Predicting a difficult airway Preparing for a difficult airway Extubation
More informationFAILED ELECTIVE INTUBATION: PLAN A- C
FAILED ELECTIVE INTUBATION: PLAN A- C MODULE: AIRWAY TARGET: NOVICE, BASIC LEVEL TRAINEES & ALL ANAESTHETISTS BACKGROUND: Management of the unexpectedly difficult airway is a core skill for all anaesthetists.
More informationAirway/Breathing. Chapter 5
Airway/Breathing Chapter 5 Airway/Breathing Introduction Rapid assessment and management of airway and ventilation are critical to preventing morbidity and mortality. Airway compromise can occur rapidly
More informationUnanticipated difficult tracheal intubation - during routine induction of anaesthesia in an adult patient
Unanticipated difficult tracheal intubation - during routine induction of anaesthesia in an adult patient Direct laryngoscopy Any problems Call for help Plan A: Initial tracheal intubation plan Direct
More informationRELEVANT AREAS OF THE ANAESTHETIC CURRICULUM
LARYNGOSPASM MODULE: CRITICAL INCIDENTS TARGET: ALL ANAESTHETISTS & INTENSIVISTS BACKGROUND: Laryngospasm is a common complication around the time of airway handling in adults and in paediatric patients.
More informationFailed tracheal intubation in obstetrics why do we need a guideline?
Failed tracheal intubation in obstetrics why do we need a guideline? Chris Elton Leicester Royal Infirmary OAA Cases & Clinical Challenges in Obstetric Anaesthesia Churchhouse Westminster 2/3/16 Declarations
More informationEmergency Department/Trauma Adult Airway Management Protocol
Emergency Department/Trauma Adult Airway Management Protocol Purpose: A standardized protocol for management of the airway in the setting of trauma in an academic center, with the goal of maximizing successful
More informationPediatric Difficult Airway Management. R2 Nichakan Rewurai R2 Pattiya Suttidate Supervisor: Assist. Prof. Sahatsa Mandee
Pediatric Difficult Airway Management R2 Nichakan Rewurai R2 Pattiya Suttidate Supervisor: Assist. Prof. Sahatsa Mandee The pediatric difficult airway is associated with a high risk for complications during
More informationAirway Management in Trauma
Editorial Volume 2 Number 1, January - June 2015 9 DOI: https://dx.doi.org/10.21088/ijaa.2349.8471.2115.1 Airway Management in Trauma The primary goal in the early treatment of the trauma patient is to
More informationHeartCode PALS. PALS Actions Overview > Legend. Contents
HeartCode PALS PALS Actions Overview > Legend Action buttons (round buttons) Clicking a round button initiates an action. Clicking this button, for example, checks the child s carotid pulse. Menu buttons
More informationPHYSICIAN COMPETENCY FOR ADULT DEEP SEDATION (Ages 14 and older)
Name Score PHYSICIAN COMPETENCY FOR ADULT DEEP SEDATION (Ages 14 and older) 1. Pre-procedure evaluation for moderate sedation should involve all of the following EXCEPT: a) Airway Exam b) Anesthetic history
More informationFacilitating EndotracheaL Intubation by Laryngoscopy technique and Apneic Oxygenation Within the Intensive Care Unit (FELLOW)
Facilitating EndotracheaL Intubation by Laryngoscopy technique and Apneic Oxygenation Within the Intensive Data Analysis Plan: Apneic Oxygenation vs. No Apneic Oxygenation Background Critically ill patients
More informationAnaesthesia > Critical Incidents > Scenario 2 (BL) Emergency Medicine > Clinical > Scenario 3
Anaesthesia > Critical Incidents > Scenario 2 (BL) SEIZURES MODULE: CRITICAL INCIDENTS TARGET: ANAESTHETISTS, INTENSIVISTS, EMERGENCY, ACUTE PHYSICIANS & FOUNDATION DOCTORS BACKGROUND: Management of seizures
More informationSurgical Care at the District Hospital. EMERGENCY & ESSENTIAL SURGICAL CARE
Surgical Care at the District Hospital 1 14 Practical Anesthesia Key Points 2 14.1 General Anesthesia Have a clear plan before starting anesthesia Never use an unfamiliar anesthetic technique in an emergency
More informationTranslaryngeal tracheostomy
Translaryngeal tracheostomy Issued: August 2013 NICE interventional procedure guidance 462 guidance.nice.org.uk/ipg462 NICE has accredited the process used by the NICE Interventional Procedures Programme
More informationGeneral Medical Procedure. Emergency Airway Techniques (General Airway Protocol)
General Medical Procedure Appropriate airway management is often the most important intervention a prehospital care provider makes, as ensuring adequate oxygenation and ventilation is crucial to the survival
More informationPOSTGRADUATE INSTITUTE OF MEDICINE UNIVERSITY OF COLOMBO
POSTGRADUATE INSTITUTE OF MEDICINE UNIVERSITY OF COLOMBO MD (ANAESTHESIOLOGY) FINAL EXAMINATION AUGUST 2013 Date : 2 nd August 2013 Time : 1.00 p.m. 4.00 p.m. Answer any three questions. Answer each question
More informationAnesthetic Techniques in Endoscopic Sinus and Skull Base Surgery
Anesthetic Techniques in Endoscopic Sinus and Skull Base Surgery Martha Cordoba Amorocho, MD Iuliu Fat, MD Supplement to Cordoba Amorocho M, Fat I. Anesthetic techniques in endoscopic sinus and skull base
More informationCricoid pressure: useful or dangerous?
Cricoid pressure: useful or dangerous? Francis VEYCKEMANS Cliniques Universitaires Saint Luc Bruxelles (2009) Controversial issue - Can J Anaesth 1997 JR Brimacombe - Pediatr Anesth 2002 JG Brock-Utne
More informationOBJECTIVES OF TRAINING FOR THE ANAESTHESIA TERM
College of Intensive Care Medicine of Australia and New Zealand ABN: 16 134 292 103 Document type: Training Date established: 2007 Date last reviewed: 2014 OBJECTIVES OF TRAINING FOR THE ANAESTHESIA TERM
More informationAngkana Lurngnateetape,, MD. Department of Anesthesiology Siriraj Hospital
AIRWAY MANAGEMENT Angkana Lurngnateetape,, MD. Department of Anesthesiology Siriraj Hospital Perhaps the most important responsibility of the anesthesiologist is management of the patient s airway Miller
More informationThe LMA CTrach TM, a new laryngeal mask airway for endotracheal intubation under vision: evaluation in 100 patients
British Journal of Anaesthesia 96 (3): 396 400 (2006) doi:10.1093/bja/ael001 Advance Access publication January 16, 2006 The LMA CTrach TM, a new laryngeal mask airway for endotracheal intubation under
More informationDisclosures. Learning Objectives. Coeditor/author. Associate Science Editor, American Heart Association
Tracheotomy Challenges for airway specialists Elizabeth H. Sinz, MD Professor of Anesthesiology & Neurosurgery Associate Dean for Clinical Simulation Disclosures Coeditor/author Associate Science Editor,
More informationHow do you use a bougie as an airway adjunct for endotracheal intubation?
Ruth Bird, MBBCh -Specialist Registrar: Anaesthesia & Paediatric Trauma Fellow Daniel Nevin, MBBCh -Consultant in Anaesthesia & Pre-Hospital Care The Royal London Hospital London s Air Ambulance (HEMS)
More informationA CRITICALLY ILL CHILD PRESENTING AT AN ACUTE TRUST- A CLINICAL AND ETHICAL CHALLENGE
A CRITICALLY ILL CHILD PRESENTING AT AN ACUTE TRUST- A CLINICAL AND ETHICAL CHALLENGE DR SRIKANTH UPPUGONDURI CONSULTANT ANAESTHESTIST NEW CROSS HOSPITAL CALL FROM PAEDIATRIC TEAM CALL FROM PAEDIATRIC
More informationRapid Sequence Induction
Rapid Sequence Induction Virtual simultaneous administration, after preoxygenation, of a potent sedative agent and a rapidly acting neuromuscular blocking agent to facilitate rapid tracheal intubation
More informationDifficult Airway Management during Anesthesia: A Review of the Incidence and Solutions
Review Article imedpub Journals http://www.imedpub.com/ Journal of Anaesthesiology and Critical Care Difficult Airway Management during Anesthesia: A Review of the Incidence and Solutions Zhiyong Zeng
More informationFAILED INTUBATION DURING RSI: PLAN A, C & D
FAILED INTUBATION DURING RSI: PLAN A, C & D MODULE: NOVICE & AIRWAY TARGET: NOVICE INITIAL ASSESSMENT OF COMPETENCY ALL ANAESTHETISTS BACKGROUND: Management of the Can t Intubate, Can t Ventilate situation
More informationINTUBATION/RSI. PURPOSE: A. To facilitate secure, definitive control of the airway by endotracheal intubation in an expeditious and safe manner
Manual: LifeLine Patient Care Protocols Section: Adult/Pediatrics Protocol #: AP1-009 Approval Date: 03/01/2018 Effective Date: 03/05/2018 Revision Due Date: 12/01/2018 INTUBATION/RSI PURPOSE: A. To facilitate
More informationRAPID SEQUENCE INTUBATION FOR THE RURAL DOC
Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR APRIL 12-14, 2018 Dr. Braam de Klerk VICTORIA BC 240 RAPID SEQUENCE INTUBATION FOR
More informationCAN T INTUBATE, CAN T VENTILATE: PLAN A- D
CAN T INTUBATE, CAN T VENTILATE: PLAN A- D MODULE: AIRWAY TARGET: BASIC LEVEL TRAINEES & ALL ANAESTHETISTS BACKGROUND: Management of the Can t Intubate, Can t Ventilate situation is a core skill for all
More information1.0 Abstract. Title. Keywords. Sevoflurane. Anaesthesia. Difficult to intubate (DTI) Rationale and Background
1.0 Abstract Title A prospective, open-label, multicenter, post marketing, observational study to investigate the effectiveness of Sevoflurane anaesthesia in difficult-to-intubate Egyptian patients. Keywords
More informationRecent Advances in Airway Management HA Convention 2014
Recent Advances in Airway Management HA Convention 2014 Dr. HK Cheng Chief of Service (Dept. of Anaesthesia & OT) Service Director (Ambulatory Surgery Centre) Tseung Kwan O Hospital Recent Advances in
More informationPDF of Trial CTRI Website URL -
Clinical Trial Details (PDF Generation Date :- Tue, 09 Oct 2018 14:20:31 GMT) CTRI Number Last Modified On 23/07/2012 Post Graduate Thesis Type of Trial Type of Study Study Design Public Title of Study
More informationAirway Management Adult
Airway Management Adult Goals: Provide effective oxygenation and ventilation; recognize and alleviate respiratory distress or failure; provide necessary interventions quickly and safely to patients who
More informationWaitin In The Wings. Esophageal/Tracheal Double Lumen Airway (Combitube ) Indications and Use for the Pre-Hospital Provider
Waitin In The Wings Esophageal/Tracheal Double Lumen Airway (Combitube ) Indications and Use for the Pre-Hospital Provider 1 CombiTube Kit General Description The CombiTube is A double-lumen tube with
More informationNational Emergency Laparotomy Audit. Help Box Text
National Emergency Laparotomy Audit Help Box Text Version Control Version 1.1 06/12/13 1.2 13/12/13 1.3 20/12/13 1.4 20/01/14 1.5 30/01/14 1.6 13/03/14 1.7 07/04/14 1.8 01/12/14 1.9 05/05/15 1.10 02/07/15
More informationNon-invasive Ventilation protocol For COPD
NHS LANARKSHIRE MONKLANDS HOSPITAL Non-invasive Ventilation protocol For COPD April 2017 S Baird Review Date: Oct 2019 Approved by Medical Directorate Indications for Non-Invasive Ventilation (NIV) NIV
More informationAdult Advanced Cardiovascular Life Support. Emergency Procedures in PT
Adult Advanced Cardiovascular Life Support Emergency Procedures in PT BLS Can be learned & practiced by the general public Includes: CPR First Aid (e.g. choking relief) Use of AED ACLS Used by healthcare
More informationCan't Intubate, Can't oxygenate (CICO) The new terminology What is the Military Experience What is the Civilian Experience What is your role.
Disclaimer The views in the presentation are the author's, and do not reflect the views of the Department of Defence I am a full time Australian Defence Force Procedural Specialist (Anaesthetist) Can't
More informationScenario title. We re Coming Down Intrahospital Transfer post MET. Designed for (specific group) ICU MET team. Scenario Design team.
Scenario title We re Coming Down Intrahospital Transfer post MET Designed for (specific group) ICU MET team Scenario Design team Name Maurice Le Guen Cameron Knott Organisation Austin Hospital Date of
More informationEquipment: NRP algorithm, MRSOPA table, medication chart, SpO 2 table Warm
NRP Skills Stations Performance Skills Station OR Integrated Skills Station STATION: Assisting with and insertion of endotracheal tube (ETT) Equipment: NRP algorithm, MRSOPA table, medication chart, SpO
More informationLEVITAN S FIBREOPTIC STYLET: BEYOND BARRIERS. - Our Perspective.
ISSN: 2250-0359 Volume 3 Issue 4 2013 LEVITAN S FIBREOPTIC STYLET: BEYOND BARRIERS - Our Perspective. Justin Ebenezer Sargunaraj * Dr.Balasubramaniam Thiagarajan * *Stanley Medical College ABSTRACT: This
More informationENDOTRACHEAL INTUBATION POLICY
POLICY Indications: Ineffective ventilation with mask and t-piece, or mask and bag technique Inability to maintain a patent airway Need or anticipation of need for prolonged ventilation Need for endotracheal
More informationEUROANESTHESIA 2008 Copenhagen, Denmark, 31 May - 3 June RC2
FIBREOPTIC INTUBATION: MODERN CLINICAL PRACTICE EUROANESTHESIA 2008 Copenhagen, Denmark, 31 May - 3 June 2008 19RC2 ADRIAN C. PEARCE Department of Anaesthesia Guy s and St Thomas Hospital London, United
More informationAirway Management and The Difficult Airway
Airway Management and The Difficult Airway Gary McCalla, MD, FACEP Medical Director REACH Air Medical Services Services 1 It is not enough to do your best, unless you have prepared to be the best. -John
More informationANAESTHESIA FOR BLEEDING TONSIL
ANAESTHESIA FOR BLEEDING TONSIL BY Dr.S.C.Ganeshprabu, MD., D.A., Professor of Anaesthesiology, Madurai Medical College & Govt. Rajaji Hospital, Madurai -652 020. A 5-year-old child who had tonsillectomy
More informationRecognizing the Difficult Airway in Pediatric Patients. Nancy L. Glass, MD, MBA,
Recognizing the Difficult Airway in Pediatric Patients Nancy L. Glass, MD, MBA, FAAP nglass@bcm.edu @DrNancyGlass1 None Disclosures Learning Objectives At the end of this presentation, participants will
More informationA Protocol for the Analysis of Clinical Incidents September Incident Summary: failure to administer anaesthetic gas at start of operation
2. Incident Summary: failure to administer anaesthetic gas at start of operation Case Summary and Chronology Patient Mrs K (25) suffers from chronic arthritis. Over the years she has undergone many elective
More informationEmergency)tracheostomy)management)/)Patent)upper)airway)
Emergency)tracheostomy)management)/)Patent)upper)airway) Call,for,airway,expert,help,,Look,,listen,&,feel,at,the,mouth,and,tracheostomy) A)Mapleson)C)system)(e.g.) Waters)circuit ))may)help)assessment)if)available)
More informationCase Report Complete Obstruction of Endotracheal Tube in an Infant with a Retropharyngeal and Anterior Mediastinal Abscess
Hindawi Case Reports in Pediatrics Volume 2017, Article ID 1848945, 4 pages https://doi.org/10.1155/2017/1848945 Case Report Complete Obstruction of Endotracheal Tube in an Infant with a Retropharyngeal
More informationAirway/Breathing. Chapter 5
Airway/Breathing Chapter 5 Airway/Breathing Introduction Skillful, rapid, assessment and management of airway and ventilation are critical to preventing morbidity and mortality. Airway compromise can occur
More informationProcedure No: Procedure Approved for Use By: WCCSS Divisional Quality Meeting. Date: May 2017
Standard Operating Procedure (SOP): Standard operating procedure for Neonatal Difficult Airway Kit and Intubation Pathway Procedure No: 1 Document replaced: Version 1 Version: 2.0 Procedure Written By:
More information